| NPI | 1811423957 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OH 35.150125) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: VA 0101265381) |
| Enumeration Date | 2017-05-10 |
| Last Update Date | 2024-07-28 |