| NPI | 1558585299 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: KY 42822) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 57.011461) |
| Enumeration Date | 2007-04-12 |
| Last Update Date | 2013-05-29 |