| NPI | 1033202015 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WA MD60126234) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 35087859) |
| Enumeration Date | 2006-10-02 |
| Last Update Date | 2021-08-03 |