| NPI | 1871721696 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WI 81640) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 35-099233) |
| Enumeration Date | 2009-07-01 |
| Last Update Date | 2023-08-01 |