| NPI | 1407592348 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX W6998) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 35.153286) |
| Enumeration Date | 2022-05-12 |
| Last Update Date | 2026-06-21 |