| NPI | 1003010117 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OR MD28723) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA A104755) |
| 207R00000X Internal Medicine (Licence: OH 57009671) | |
| Enumeration Date | 2007-06-13 |
| Last Update Date | 2023-03-07 |