| NPI | 1720243181 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX P5983) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MT193132) |
| 207R00000X Internal Medicine (Licence: PA MD443160) | |
| 207R00000X Internal Medicine (Licence: OH 35.120688) | |
| Enumeration Date | 2008-07-25 |
| Last Update Date | 2025-12-01 |