| NPI | 1013016542 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME118071) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 35.128258) |
| Enumeration Date | 2006-09-21 |
| Last Update Date | 2016-07-27 |