| NPI | 1750688651 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OH 57.014328) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: VA 0101249792) |
| Enumeration Date | 2011-02-12 |
| Last Update Date | 2021-02-24 |