| NPI | 1174564785 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OH 35-05-9908) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WV 16693) |
| Enumeration Date | 2006-06-08 |
| Last Update Date | 2021-01-14 |