| NPI | 1386777118 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OH 35-043804) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: KY 36684) |
| Enumeration Date | 2007-03-13 |
| Last Update Date | 2015-10-29 |