| NPI | 1588003792 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OH 35.136211) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX BP10047620) |
| Enumeration Date | 2013-06-20 |
| Last Update Date | 2019-09-12 |