| NPI | 1134246374 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX N1505) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 57009919) |
| Enumeration Date | 2007-03-23 |
| Last Update Date | 2013-04-23 |