| NPI | 1699126672 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX T3859) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 35076235) |
| 207R00000X Internal Medicine (Licence: MI 4301110057) | |
| Enumeration Date | 2016-06-30 |
| Last Update Date | 2026-08-06 |