| NPI | 1629148432 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WV 11189) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 35-05-4845R) |
| Enumeration Date | 2006-11-09 |
| Last Update Date | 2015-03-23 |