| NPI | 1326088402 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: GA 066804) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 35.080564) |
| Enumeration Date | 2006-06-07 |
| Last Update Date | 2017-05-02 |