| NPI | 1063623767 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OH 35094199) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 57012534) |
| Enumeration Date | 2007-05-24 |
| Last Update Date | 2016-12-19 |