| NPI | 1851417729 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: SC 31626) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 57010107) |
| 207RG0300X Internal Medicine, Geriatric Medicine (Licence: SC TL31626) | |
| Enumeration Date | 2007-03-22 |
| Last Update Date | 2014-10-02 |