| NPI | 1245276633 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: VA 0101265747) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MD467675) |
| 207R00000X Internal Medicine (Licence: OR MD25531) | |
| 207R00000X Internal Medicine (Licence: MD D89332) | |
| 207R00000X Internal Medicine (Licence: OH 35.141341) | |
| Enumeration Date | 2006-06-22 |
| Last Update Date | 2022-02-14 |