| NPI | 1942615455 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OH 35.138357) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 4301105520) |
| Enumeration Date | 2014-06-23 |
| Last Update Date | 2023-11-03 |