| NPI | 1053302018 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: KY 39184) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 35069035) |
| Enumeration Date | 2005-10-31 |
| Last Update Date | 2022-02-08 |