| NPI | 1528486453 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OH 35130115) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 57.024342) |
| Enumeration Date | 2014-03-28 |
| Last Update Date | 2022-07-21 |