| NPI | 1902834492 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OH 35.075805) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: KY 45749) |
| Enumeration Date | 2006-06-30 |
| Last Update Date | 2020-02-13 |