| NPI | 1114049475 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MI 4301087281) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 35.093572) |
| Enumeration Date | 2007-04-05 |
| Last Update Date | 2015-05-27 |