| NPI | 1467718460 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OH 125989) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: KY R3035) |
| Enumeration Date | 2012-04-04 |
| Last Update Date | 2022-01-24 |