| NPI | 1497053755 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OH 35.096699) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: LA MD.206300) |
| Enumeration Date | 2011-03-09 |
| Last Update Date | 2021-12-17 |