| NPI | 1669867065 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OH 35.132166) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 57.026567) |
| Enumeration Date | 2015-04-02 |
| Last Update Date | 2018-07-06 |