| NPI | 1154959237 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PA OS022611) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 58.031336) |
| Enumeration Date | 2020-04-01 |
| Last Update Date | 2023-06-13 |