| NPI | 1407054331 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OH 35.088302) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IA 37124) |
| Enumeration Date | 2007-07-03 |
| Last Update Date | 2023-03-07 |