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 | 2023-08-21 |