| NPI | 1629058037 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IN 01089273A) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 35075603) |
| Enumeration Date | 2006-01-20 |
| Last Update Date | 2023-01-19 |