| NPI | 1841285087 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: GA 048329) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: GA 48329) |
| 207R00000X Internal Medicine (Licence: OH 35073659A) | |
| Enumeration Date | 2005-09-14 |
| Last Update Date | 2018-11-14 |