| NPI | 1851588800 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MO 2015020230) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 34.009146) |
| Enumeration Date | 2007-10-03 |
| Last Update Date | 2016-01-26 |