| NPI | 1740215409 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: OH 35.071695) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 214312) |
| 207R00000X Internal Medicine (Licence: OH 35.071695) | |
| Enumeration Date | 2006-07-11 |
| Last Update Date | 2022-05-04 |