| NPI | 1245849892 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA A185951) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 57.249573) |
| Enumeration Date | 2020-07-29 |
| Last Update Date | 2025-02-07 |