| NPI | 1720410566 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OH 35.135895) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 256997) |
| 207R00000X Internal Medicine (Licence: MS 24465) | |
| Enumeration Date | 2013-08-03 |
| Last Update Date | 2019-07-09 |