| NPI | 1376123075 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OH 35.150926) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 1376123075) |
| Enumeration Date | 2021-04-08 |
| Last Update Date | 2024-09-12 |