| NPI | 1164497053 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RA0401X Internal Medicine, Addiction Medicine (Licence: OH 35.080110) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 820583807) |
| Enumeration Date | 2006-02-22 |
| Last Update Date | 2019-01-03 |