| NPI | 1124284468 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME107259) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 57.010862) |
| Enumeration Date | 2008-08-06 |
| Last Update Date | 2025-12-11 |