| NPI | 1528590379 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IN 02007167A) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 34.014305) |
| Enumeration Date | 2017-03-31 |
| Last Update Date | 2023-09-01 |