| NPI | 1619280674 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME152130) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 35.096312) |
| Enumeration Date | 2010-07-20 |
| Last Update Date | 2022-01-18 |