| NPI | 1245511955 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WV 27255) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 57.019005) |
| Enumeration Date | 2011-09-08 |
| Last Update Date | 2021-03-30 |