| NPI | 1780614974 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OH 35.085521) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: KY 39418) |
| Enumeration Date | 2006-07-03 |
| Last Update Date | 2020-11-04 |