| NPI | 1609824846 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX 46083) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 35-068199) |
| Enumeration Date | 2006-05-04 |
| Last Update Date | 2018-03-17 |