| NPI | 1689092041 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX S0654) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 130080) |
| Enumeration Date | 2014-04-02 |
| Last Update Date | 2020-05-06 |