| NPI | 1578724886 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: GA 66531) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 35.097246) |
| Enumeration Date | 2008-06-19 |
| Last Update Date | 2024-06-21 |