| NPI | 1609867225 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX N8232) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 35.085070) |
| Enumeration Date | 2005-11-02 |
| Last Update Date | 2011-03-05 |