| NPI | 1730744053 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PA OS022000) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 58.031046) |
| Enumeration Date | 2019-05-02 |
| Last Update Date | 2023-07-27 |