| NPI | 1124328224 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NE 29692) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 57018342) |
| Enumeration Date | 2010-10-25 |
| Last Update Date | 2017-02-17 |