| NPI | 1376632687 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MN 26226) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 122180) |
| Enumeration Date | 2006-10-12 |
| Last Update Date | 2014-08-12 |