| NPI | 1831628981 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: VA 0102207587) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 34.014257) |
| Enumeration Date | 2017-06-11 |
| Last Update Date | 2023-02-03 |