| NPI | 1639402795 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NC 2012-01869) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 099138) |
| Enumeration Date | 2009-09-08 |
| Last Update Date | 2015-04-20 |