| NPI | 1154521979 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: KY 41187) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 090370) |
| Enumeration Date | 2007-07-19 |
| Last Update Date | 2020-12-07 |