| NPI | 1356912950 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IA MD-52885) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 57.251486) |
| Enumeration Date | 2021-07-05 |
| Last Update Date | 2025-02-25 |