| NPI | 1396734802 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX P0046) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 35073719) |
| Enumeration Date | 2005-10-18 |
| Last Update Date | 2013-09-23 |