| NPI | 1831115484 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX N2458) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 35-086929) |
| Enumeration Date | 2006-07-15 |
| Last Update Date | 2022-07-21 |