| NPI | 1932653011 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME161686) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 57-027889) |
| 207R00000X Internal Medicine (Licence: IN 01081691A) | |
| Enumeration Date | 2016-08-07 |
| Last Update Date | 2024-10-10 |