| NPI | 1124024625 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME101224) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: OH 35-08-2150-0) |
| Enumeration Date | 2005-06-21 |
| Last Update Date | 2022-07-21 |