| NPI | 1750587580 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX R0181) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 35.095606) |
| Enumeration Date | 2007-06-27 |
| Last Update Date | 2026-09-10 |