| NPI | 1801030275 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WA MD 60071840) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 57.012226) |
| Enumeration Date | 2009-04-28 |
| Last Update Date | 2010-12-13 |