| NPI | 1245353267 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OH 35094054) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 4301088105) |
| Enumeration Date | 2007-04-06 |
| Last Update Date | 2023-11-03 |