| NPI | 1386173565 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MO 2017016921) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 35.139388) |
| Enumeration Date | 2017-06-09 |
| Last Update Date | 2022-08-04 |