| NPI | 1710980941 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OH 3580747) |
| Additional Taxonomies | 174400000X Specialist (Licence: OH 3580747) |
| Enumeration Date | 2005-05-23 |
| Last Update Date | 2018-01-29 |