| NPI | 1225419443 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OH 35131389) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 281672) |
| Enumeration Date | 2015-06-12 |
| Last Update Date | 2020-05-29 |