| NPI | 1770584617 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: KY 51381) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: KY TP548) |
| 207R00000X Internal Medicine (Licence: OH 35-064236) | |
| Enumeration Date | 2005-08-02 |
| Last Update Date | 2020-12-01 |