| NPI | 1649599218 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OH 35.131371) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WY 8642A) |
| 207R00000X Internal Medicine (Licence: OH 57.014293) | |
| Enumeration Date | 2010-05-21 |
| Last Update Date | 2019-08-20 |