| NPI | 1134175409 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OH 35081160) |
| Additional Taxonomies | 208VP0000X (Licence: OH 35081160) |
| Enumeration Date | 2006-05-26 |
| Last Update Date | 2020-11-11 |