| NPI | 1962663963 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: SC 31051) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 35098893) |
| 207R00000X Internal Medicine (Licence: SC LL31051) | |
| Enumeration Date | 2008-06-23 |
| Last Update Date | 2020-10-15 |