| NPI | 1538377478 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX N5983) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 57010379) |
| Enumeration Date | 2007-05-21 |
| Last Update Date | 2014-02-26 |