| NPI | 1063804946 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NY 299459) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 34.013131) |
| Enumeration Date | 2015-03-02 |
| Last Update Date | 2023-02-02 |