| NPI | 1295026607 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: VA 0101264542) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 35.123647) |
| Enumeration Date | 2011-04-20 |
| Last Update Date | 2021-01-15 |