| NPI | 1194706408 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA 161010) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 35076345) |
| Enumeration Date | 2005-11-14 |
| Last Update Date | 2019-07-17 |