| NPI | 1770848640 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MA 1014272) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NM MD2018-0147) |
| 207R00000X Internal Medicine (Licence: IL 125061149) | |
| 207R00000X Internal Medicine (Licence: OH 35.125961) | |
| Enumeration Date | 2012-07-06 |
| Last Update Date | 2023-06-23 |