NPI | 1053302018 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 207R00000X Internal Medicine (Licence: KY 39184) |
Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 35069035) |
Enumeration Date | 2005-10-31 |
Last Update Date | 2022-02-08 |