| NPI | 1629024112 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OH 35- 07-6961) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: KY 49624) |
| Enumeration Date | 2006-05-26 |
| Last Update Date | 2017-02-09 |