| NPI | 1104810886 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OH 35.097869) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 036-112577) |
| 207R00000X Internal Medicine (Licence: IA 35665) | |
| Enumeration Date | 2005-09-08 |
| Last Update Date | 2023-03-07 |