| NPI | 1457390213 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MI 4301067045) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 35078247V) |
| Enumeration Date | 2006-06-06 |
| Last Update Date | 2008-03-05 |