| NPI | 1902864416 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: KY 30674) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 35-064929) |
| Enumeration Date | 2006-05-03 |
| Last Update Date | 2014-05-15 |