| NPI | 1376529461 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: KY 45251) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: KY TP405) |
| 207R00000X Internal Medicine (Licence: OH 35043698) | |
| Enumeration Date | 2005-12-20 |
| Last Update Date | 2018-09-12 |