| NPI | 1922374024 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IL 036136651) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 57.021303) |
| 207R00000X Internal Medicine (Licence: CO DR.0058523) | |
| Enumeration Date | 2012-03-23 |
| Last Update Date | 2017-10-09 |