| NPI | 1760549240 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OH 89029) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NC 2014-01417) |
| Enumeration Date | 2007-01-03 |
| Last Update Date | 2022-05-04 |