| NPI | 1811540800 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OH 35.146528) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MD482893) |
| 207R00000X Internal Medicine (Licence: WV 33449) | |
| 207R00000X Internal Medicine (Licence: IN 01090854A) | |
| Enumeration Date | 2019-07-19 |
| Last Update Date | 2024-02-06 |