| NPI | 1760698567 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NV DO1844) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 58.001943) |
| Enumeration Date | 2007-05-16 |
| Last Update Date | 2019-06-18 |