| NPI | 1811376023 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NY 296036) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 35.134000) |
| Enumeration Date | 2015-05-20 |
| Last Update Date | 2021-01-28 |