| NPI | 1497711626 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA C54460) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 35086775) |
| Enumeration Date | 2006-04-25 |
| Last Update Date | 2021-11-29 |