| NPI | 1013322056 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA A153850) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 57.024057) |
| 207R00000X Internal Medicine (Licence: OH 129444) | |
| Enumeration Date | 2014-06-29 |
| Last Update Date | 2018-10-18 |