| NPI | 1588828933 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME131082) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 35.097993) |
| Enumeration Date | 2008-07-15 |
| Last Update Date | 2018-12-31 |