| NPI | 1912995812 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OH 47366) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: AL 00007427) |
| Enumeration Date | 2005-10-13 |
| Last Update Date | 2012-04-11 |