| NPI | 1154403921 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA A35708) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 35066781) |
| Enumeration Date | 2006-10-20 |
| Last Update Date | 2022-08-15 |