| NPI | 1528544525 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OH 35.147744) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MO 2020019302) |
| Enumeration Date | 2018-07-13 |
| Last Update Date | 2023-06-03 |