| NPI | 1629325634 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RE0101X Internal Medicine Endocrinology, Diabetes & Metabolism (Licence: FL ME119454) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 35-048933) |
| 207R00000X Internal Medicine (Licence: KY 45727) | |
| 207RE0101X Internal Medicine Endocrinology, Diabetes & Metabolism (Licence: OH 35-048933) | |
| 207RE0101X Internal Medicine Endocrinology, Diabetes & Metabolism (Licence: KY 45727) | |
| 207RG0300X Internal Medicine Geriatric Medicine (Licence: KY 45727) | |
| Enumeration Date | 2012-08-08 |
| Last Update Date | 2018-03-17 |