| NPI | 1770589384 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX M1514) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 35-07-6383) |
| Enumeration Date | 2005-06-28 |
| Last Update Date | 2020-10-20 |