| NPI | 1568802973 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: ND 14044) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 57022397) |
| Enumeration Date | 2013-06-29 |
| Last Update Date | 2017-05-05 |