| NPI | 1437107034 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OH 35.126007)  | 
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL ME79597)  | 
| Enumeration Date | 2006-05-05 | 
| Last Update Date | 2020-10-05 |