| NPI | 1528371192 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME163988) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 35.153902) |
| Enumeration Date | 2010-07-23 |
| Last Update Date | 2026-05-11 |