| NPI | 1144504085 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NM MD2023-0073) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: NC 2012-01310) |
| 207R00000X Internal Medicine (Licence: OH 57019752) | |
| 2083A0100X Preventive Medicine, Aerospace Medicine (Licence: NC 2012-01310) | |
| Enumeration Date | 2011-10-10 |
| Last Update Date | 2024-08-09 |