| NPI | 1518482736 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MT MED-PHYS-LIC-87696) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 57.257172) |
| Enumeration Date | 2017-08-09 |
| Last Update Date | 2024-06-20 |