| NPI | 1275156911 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NY 325060) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 57.249699) |
| Enumeration Date | 2020-05-27 |
| Last Update Date | 2023-07-27 |