| NPI | 1417044355 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OH 35.128129) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: VA 0101241946) |
| Enumeration Date | 2006-10-10 |
| Last Update Date | 2021-01-27 |