| NPI | 1447498829 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WA 60630632) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 35.120263) |
| Enumeration Date | 2009-01-23 |
| Last Update Date | 2019-11-06 |