| NPI | 1508896960 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IN 01036460A) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 35.077693) |
| Enumeration Date | 2006-07-03 |
| Last Update Date | 2021-05-12 |