| NPI | 1518996792 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: AZ 60069) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 35-05-3812) |
| Enumeration Date | 2006-07-01 |
| Last Update Date | 2022-12-22 |