| NPI | 1790727139 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA C52852) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: GA 73366) |
| 207R00000X Internal Medicine (Licence: OH 35073847) | |
| Enumeration Date | 2006-06-11 |
| Last Update Date | 2023-01-11 |