| NPI | 1578670576 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OH 34.010066) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: LA 21798) |
| Enumeration Date | 2006-08-24 |
| Last Update Date | 2013-12-09 |