| NPI | 1124307459 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: GA 86073) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 35.125999) |
| 207R00000X Internal Medicine (Licence: MI 4301098441) | |
| Enumeration Date | 2011-08-04 |
| Last Update Date | 2023-02-10 |