| NPI | 1669807244 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX S9894) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 57.022671) |
| Enumeration Date | 2013-09-13 |
| Last Update Date | 2026-09-10 |