| NPI | 1063517142 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MI 4301098006) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IA 36612) |
| 207R00000X Internal Medicine (Licence: OH 85477) | |
| Enumeration Date | 2006-09-14 |
| Last Update Date | 2016-06-22 |