| NPI | 1205270766 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA A170343) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 35.132769) |
| Enumeration Date | 2013-04-26 |
| Last Update Date | 2021-08-25 |