| NPI | 1518461755 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WV 30413) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 57.245720) |
| Enumeration Date | 2018-03-21 |
| Last Update Date | 2023-12-25 |