NPI | 1538513866 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX S0409) |
Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 34.013562) |
Enumeration Date | 2016-04-23 |
Last Update Date | 2021-09-30 |