| NPI | 1942247549 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OH 35.088672) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 4301080670) |
| Enumeration Date | 2006-06-01 |
| Last Update Date | 2013-11-14 |