| NPI | 1568872711 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WA MD60745155) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 57.025099) |
| Enumeration Date | 2014-04-28 |
| Last Update Date | 2021-06-28 |