| NPI | 1770505174 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PA OS008267L) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 34008265) |
| Enumeration Date | 2006-07-24 |
| Last Update Date | 2015-09-16 |