| NPI | 1285164129 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OH 35.138064) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 125.070180) |
| Enumeration Date | 2017-06-13 |
| Last Update Date | 2021-12-20 |