| NPI | 1962448688 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OH 35.084940) |
| Additional Taxonomies | 207QA0505X Family Medicine, Adult Medicine (Licence: OH 35084940) |
| Enumeration Date | 2006-06-21 |
| Last Update Date | 2021-12-15 |