| NPI | 1891296562 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RE0101X Internal Medicine, Endocrinology, Diabetes & Metabolism (Licence: OH 50.005499RX) |
| Additional Taxonomies | 363A00000X Physician Assistant |
| Enumeration Date | 2018-02-27 |
| Last Update Date | 2023-06-30 |