| NPI | 1477086742 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OH 35.142547) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: KY 55495) |
| Enumeration Date | 2017-04-04 |
| Last Update Date | 2021-07-21 |