| NPI | 1902469026 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OH 35.151287) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 57.248229) |
| Enumeration Date | 2019-04-15 |
| Last Update Date | 2024-07-19 |