| NPI | 1861928962 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NC 2023-00068) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 34.013635) |
| Enumeration Date | 2017-05-10 |
| Last Update Date | 2024-06-10 |