| NPI | 1780845255 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX P1254) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OH 34.009279) |
| Enumeration Date | 2008-06-18 |
| Last Update Date | 2023-11-22 |