| NPI | 1770920209 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MD D86223) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 35.128239) |
| Enumeration Date | 2013-05-23 |
| Last Update Date | 2019-10-08 |