| NPI | 1831680941 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: TX t8018) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 58.030252) |
| Enumeration Date | 2018-05-24 |
| Last Update Date | 2023-03-07 |