| NPI | 1750383550 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NC 2016-00627) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 34008518) |
| Enumeration Date | 2005-08-11 |
| Last Update Date | 2024-02-22 |