| NPI | 1184607749 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME153631) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 35-07-5025) |
| Enumeration Date | 2005-11-28 |
| Last Update Date | 2025-03-04 |