| NPI | 1861416281 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: SC 1001) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 34008521) |
| Enumeration Date | 2006-07-27 |
| Last Update Date | 2011-03-30 |