| NPI | 1710328604 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OH 35 128788) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 4301102623) |
| Enumeration Date | 2013-07-09 |
| Last Update Date | 2019-03-21 |