| NPI | 1952515421 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA C151923) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 57009970) |
| Enumeration Date | 2007-05-10 |
| Last Update Date | 2017-10-12 |