| NPI | 1679591234 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OH 34.006984) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IN 02003004A) |
| Enumeration Date | 2006-07-18 |
| Last Update Date | 2018-01-25 |