| NPI | 1316926249 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: LA 206831) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 35.040949) |
| Enumeration Date | 2006-01-10 |
| Last Update Date | 2014-09-12 |