| NPI | 1235517582 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OH 35132068) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL ME154928) |
| Enumeration Date | 2015-05-07 |
| Last Update Date | 2024-02-07 |