| NPI | 1487843777 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: SC 35180) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NC 2010-01489) |
| 207R00000X Internal Medicine (Licence: OH 57013088) | |
| Enumeration Date | 2007-10-23 |
| Last Update Date | 2021-04-05 |