| NPI | 1386169761 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX S4760) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 57.245120) |
| Enumeration Date | 2017-08-07 |
| Last Update Date | 2026-01-29 |