| NPI | 1689988941 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MN 59453) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 57.017361) |
| Enumeration Date | 2010-07-28 |
| Last Update Date | 2022-07-21 |