| NPI | 1710142518 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: AZ 45278) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 57014288) |
| Enumeration Date | 2008-07-22 |
| Last Update Date | 2016-01-15 |