| NPI | 1639625486 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NY 298794) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 57.028651) |
| Enumeration Date | 2016-08-31 |
| Last Update Date | 2023-03-07 |