| NPI | 1558863464 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MO 2021029585) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 34.014279) |
| Enumeration Date | 2018-03-07 |
| Last Update Date | 2021-08-11 |