| NPI | 1144225053 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MD D68176) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 35082765T) |
| Enumeration Date | 2005-06-16 |
| Last Update Date | 2011-11-08 |