| NPI | 1295767317 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: SC 81757) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 4301081755) |
| Enumeration Date | 2006-07-07 |
| Last Update Date | 2021-03-15 |