| NPI | 1083680508 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: VA 0101237947) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 35.09333) |
| Enumeration Date | 2006-02-24 |
| Last Update Date | 2022-09-20 |