| NPI | 1376599183 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX N6171) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 35052151) |
| Enumeration Date | 2006-05-25 |
| Last Update Date | 2019-09-04 |