| NPI | 1235188087 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME122203) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 35074578) |
| Enumeration Date | 2006-05-09 |
| Last Update Date | 2015-02-02 |