| NPI | 1518961374 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PA MD465566) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 35079305) |
| Enumeration Date | 2005-06-09 |
| Last Update Date | 2020-08-30 |