| NPI | 1962604892 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MN 51130) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 35089729) |
| Enumeration Date | 2007-06-04 |
| Last Update Date | 2023-11-30 |