| NPI | 1053495325 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OH 35.083979) |
| Additional Taxonomies | 174400000X Specialist (Licence: OH 35.083979) |
| Enumeration Date | 2006-10-24 |
| Last Update Date | 2022-01-17 |