| NPI | 1164865259 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME137380) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 35-128949) |
| 207R00000X Internal Medicine (Licence: SC MD52572) | |
| Enumeration Date | 2013-04-09 |
| Last Update Date | 2024-02-23 |