| NPI | 1629033246 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TN 42883) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WV 21665) |
| 207R00000X Internal Medicine (Licence: OH 35.085353) | |
| Enumeration Date | 2006-04-18 |
| Last Update Date | 2018-11-02 |