| NPI | 1598970626 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA C54978) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 35.088338) |
| Enumeration Date | 2007-05-11 |
| Last Update Date | 2013-05-23 |