| NPI | 1770785115 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OH 35.098499) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: KY 42810) |
| Enumeration Date | 2007-06-05 |
| Last Update Date | 2012-05-30 |