| NPI | 1114313012 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OH 35132869) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 57.026988) |
| Enumeration Date | 2015-04-08 |
| Last Update Date | 2018-04-06 |