| NPI | 1205178449 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MA 281373) |
| Additional Taxonomies | 174400000X Specialist (Licence: OH 35127863) |
| 207R00000X Internal Medicine (Licence: OH 35127863) | |
| Enumeration Date | 2013-03-26 |
| Last Update Date | 2019-10-01 |