| NPI | 1073512273 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OH 91234) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 235143) |
| Enumeration Date | 2005-07-19 |
| Last Update Date | 2024-05-17 |