| NPI | 1730118175 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: VA 0101037433) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 35-053984) |
| Enumeration Date | 2006-06-30 |
| Last Update Date | 2014-07-15 |