| NPI | 1871641647 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OH 35078757) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA A55522) |
| Enumeration Date | 2007-01-08 |
| Last Update Date | 2007-07-08 |