| NPI | 1518224872 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RP1001X Internal Medicine, Pulmonary Disease (Licence: OH 35135125) |
| Additional Taxonomies | 208D00000X General Practice (Licence: VA 0101255503) |
| Enumeration Date | 2012-04-11 |
| Last Update Date | 2019-07-10 |