| NPI | 1770710378 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OH 35-092905) | 
| Additional Taxonomies | 207RH0002X Internal Medicine, Hospice and Palliative Medicine (Licence: OH 35-092905) | 
| Enumeration Date | 2009-06-22 | 
| Last Update Date | 2019-06-11 |