| NPI | 1114364460 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OH 35.128887) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MT204565) |
| Enumeration Date | 2013-05-28 |
| Last Update Date | 2022-04-08 |