| NPI | 1508060229 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WI 52719) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 57011524) |
| Enumeration Date | 2007-06-14 |
| Last Update Date | 2014-02-04 |