| NPI | 1811004773 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME136120) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 35-062906) |
| Enumeration Date | 2006-08-24 |
| Last Update Date | 2018-10-24 |