| NPI | 1508244179 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX R7871) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 35.134290) |
| Enumeration Date | 2015-05-14 |
| Last Update Date | 2025-04-14 |