| NPI | 1669737706 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME156034) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 35125917) |
| 207R00000X Internal Medicine (Licence: IL 036.142028) | |
| Enumeration Date | 2012-07-04 |
| Last Update Date | 2023-02-23 |