| NPI | 1962431957 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OH 35.080624) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 80624) |
| Enumeration Date | 2006-07-02 |
| Last Update Date | 2021-02-22 |