| NPI | 1124507074 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OH 57.245345) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 35.140061) |
| Enumeration Date | 2018-08-11 |
| Last Update Date | 2021-12-22 |