| NPI | 1700832300 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OH 35085413) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: KY 38955) |
| 207R00000X Internal Medicine (Licence: IL 36116671) | |
| Enumeration Date | 2006-05-25 |
| Last Update Date | 2009-03-13 |