| NPI | 1982968129 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MO 2017001080) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 280374) |
| 207R00000X Internal Medicine (Licence: OH 35.134257) | |
| Enumeration Date | 2012-07-03 |
| Last Update Date | 2019-04-26 |