| NPI | 1699731760 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: ID M-11876) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MN 25689) |
| 207R00000X Internal Medicine (Licence: OH 35.098146) | |
| Enumeration Date | 2006-04-26 |
| Last Update Date | 2013-02-21 |