| NPI | 1821384058 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX Q7151) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 35.123405) |
| 207R00000X Internal Medicine (Licence: GA 005072) | |
| Enumeration Date | 2011-06-27 |
| Last Update Date | 2022-08-12 |