| NPI | 1336769702 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OH 34.016378) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 125.075619) |
| Enumeration Date | 2020-04-25 |
| Last Update Date | 2023-08-16 |