| NPI | 1851629521 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NM MD2019-0071) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 35.097909) |
| 207R00000X Internal Medicine (Licence: IA MD-44280) | |
| Enumeration Date | 2009-11-18 |
| Last Update Date | 2023-09-29 |