| NPI | 1649732520 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX T6284) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 58.030627) |
| Enumeration Date | 2019-04-01 |
| Last Update Date | 2023-03-02 |