| NPI | 1467408344 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208VP0000X (Licence: MI 4301097463) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 35083611A) |
| Enumeration Date | 2006-05-25 |
| Last Update Date | 2025-06-19 |