| NPI | 1215516273 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OH 34.017231) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 328092) |
| Enumeration Date | 2021-04-06 |
| Last Update Date | 2024-05-08 |