| 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 |