| NPI | 1619936689 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OH 35039948) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: KY 44572) |
| Enumeration Date | 2006-03-20 |
| Last Update Date | 2011-10-25 |