| NPI | 1619195427 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA A107211) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 57012501) |
| Enumeration Date | 2007-04-24 |
| Last Update Date | 2024-10-30 |