| NPI | 1194918094 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NC 19209) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WI 50461) |
| 207R00000X Internal Medicine (Licence: OH 35.061654) | |
| Enumeration Date | 2007-08-23 |
| Last Update Date | 2019-02-22 |