| NPI | 1114183878 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PA MD462425) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 57.014546) |
| Enumeration Date | 2008-08-01 |
| Last Update Date | 2019-11-07 |