| NPI | 1164545190 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IN 01048866A) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 35075289) |
| Enumeration Date | 2007-04-06 |
| Last Update Date | 2015-08-17 |