| NPI | 1972820090 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MO 2024000701) |
| Additional Taxonomies | 208M00000X Hospitalist (Licence: MO 2024000701) |
| 207R00000X Internal Medicine (Licence: KS 05-41403) | |
| 207R00000X Internal Medicine (Licence: OK DO) | |
| Enumeration Date | 2010-04-28 |
| Last Update Date | 2026-05-07 |