| NPI | 1124319629 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OH 35123609) |
| Additional Taxonomies | 208600000X Surgery (Licence: NY 250277) |
| 208600000X Surgery (Licence: OH 123609) | |
| Enumeration Date | 2011-05-02 |
| Last Update Date | 2015-03-06 |