| NPI | 1750720827 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OH 35.127962) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MT-205191) |
| Enumeration Date | 2013-06-21 |
| Last Update Date | 2024-03-04 |