| NPI | 1699938779 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NV 26391) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 35120442) |
| Enumeration Date | 2008-07-08 |
| Last Update Date | 2025-03-05 |