| NPI | 1639294796 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL OS5845) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 34002466) |
| Enumeration Date | 2007-03-20 |
| Last Update Date | 2012-04-03 |