NPI | 1851396840 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME164761) |
Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 35064619) |
207R00000X Internal Medicine (Licence: OH 35064619L) | |
Enumeration Date | 2005-06-16 |
Last Update Date | 2025-07-24 |