| NPI | 1154914745 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OH 35.149763) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NJ 0000) |
| Enumeration Date | 2021-02-16 |
| Last Update Date | 2024-01-11 |