| NPI | 1598058422 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OH 35.129172) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 4301098256) |
| Enumeration Date | 2011-05-25 |
| Last Update Date | 2016-10-31 |