| NPI | 1912090457 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CO 52879) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 35060038K) |
| Enumeration Date | 2006-10-02 |
| Last Update Date | 2020-07-07 |