| NPI | 1912263922 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WV 28313) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 35.125418) |
| Enumeration Date | 2012-04-03 |
| Last Update Date | 2022-04-07 |