| NPI | 1922128339 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME106077) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 57012674) |
| Enumeration Date | 2007-03-30 |
| Last Update Date | 2021-04-09 |