| NPI | 1649400581 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: AZ 49923) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 120199) |
| Enumeration Date | 2009-07-24 |
| Last Update Date | 2021-09-13 |