| NPI | 1568825552 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OH 35.148071) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 279280) |
| Enumeration Date | 2016-03-29 |
| Last Update Date | 2023-06-21 |