| NPI | 1831353283 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OH 35126820) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MO 2008017234) |
| Enumeration Date | 2008-07-15 |
| Last Update Date | 2021-06-09 |