| NPI | 1649610114 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OH 35-127407) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 57.020905) |
| Enumeration Date | 2013-06-28 |
| Last Update Date | 2017-02-20 |