| NPI | 1922441435 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: AZ 53512) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 35.130052) |
| Enumeration Date | 2013-04-15 |
| Last Update Date | 2018-03-17 |