| NPI | 1134502594 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX T4295) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 4301108462) |
| 207R00000X Internal Medicine (Licence: OH 35.138345) | |
| Enumeration Date | 2015-07-02 |
| Last Update Date | 2022-07-26 |