| NPI | 1114900305 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OH 35.091068) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MD045045E) |
| Enumeration Date | 2005-11-22 |
| Last Update Date | 2013-01-07 |