| NPI | 1760645170 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OH 34.010910) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA OT012736) |
| Enumeration Date | 2008-07-07 |
| Last Update Date | 2020-04-07 |