| NPI | 1720015787 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OH 35-083710) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: KY 49975) |
| 207R00000X Internal Medicine (Licence: CA G46041) | |
| Enumeration Date | 2006-06-27 |
| Last Update Date | 2021-02-22 |