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 |