| NPI | 1568655181 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OH 35-125340) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MO 2010033325) |
| Enumeration Date | 2007-08-27 |
| Last Update Date | 2015-08-31 |