| NPI | 1477796761 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX Q6569) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 35096841) |
| Enumeration Date | 2009-04-16 |
| Last Update Date | 2025-09-11 |