| NPI | 1013965532 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: SC 1431) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 34004891C) |
| Enumeration Date | 2006-05-05 |
| Last Update Date | 2021-06-24 |