| NPI | 1568428613 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TN 43763) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 3587625) |
| Enumeration Date | 2006-04-25 |
| Last Update Date | 2020-07-22 |