| NPI | 1558619668 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OH 35.123472) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MS 26887) |
| Enumeration Date | 2012-08-21 |
| Last Update Date | 2021-09-20 |