| NPI | 1659714798 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TN 54058) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 35.125878) |
| Enumeration Date | 2013-04-08 |
| Last Update Date | 2016-06-28 |