| NPI | 1487195335 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MD H0091739) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 34.014097) |
| Enumeration Date | 2017-03-12 |
| Last Update Date | 2021-07-12 |