| NPI | 1831142439 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: KY 51780) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 35078434) |
| 207RG0300X Internal Medicine, Geriatric Medicine (Licence: OH 35078434) | |
| Enumeration Date | 2006-05-18 |
| Last Update Date | 2025-04-29 |