| NPI | 1245598416 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OR MD171549) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 099206) |
| Enumeration Date | 2012-04-25 |
| Last Update Date | 2022-05-03 |