| NPI | 1649357724 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OH 35.089624) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH Ohio training) |
| Enumeration Date | 2006-11-01 |
| Last Update Date | 2017-05-04 |