| NPI | 1366618167 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX P5715) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IA 38489) |
| 207R00000X Internal Medicine (Licence: OH 35.140415) | |
| Enumeration Date | 2008-05-01 |
| Last Update Date | 2023-08-21 |