| NPI | 1730504044 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OH 35045531) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: KY 21151) |
| Enumeration Date | 2014-02-24 |
| Last Update Date | 2016-12-13 |