| NPI | 1962923805 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OH 35.144863) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WV 31039) |
| Enumeration Date | 2017-06-30 |
| Last Update Date | 2024-07-03 |