| NPI | 1568500379 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NC 2007-00300) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 35.080273) |
| Enumeration Date | 2007-02-02 |
| Last Update Date | 2011-09-28 |