| NPI | 1104080977 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RE0101X Internal Medicine, Endocrinology, Diabetes & Metabolism (Licence: OH 34.013718) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 34.013718) |
| 207R00000X Internal Medicine (Licence: MI 5101017743) | |
| Enumeration Date | 2008-07-10 |
| Last Update Date | 2021-03-18 |