| NPI | 1548822588 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OH 57.247165) |
| Additional Taxonomies | 207RC0200X Internal Medicine, Critical Care Medicine (Licence: WI 76789-20) |
| Enumeration Date | 2019-06-30 |
| Last Update Date | 2022-04-12 |