| NPI | 1952561755 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA A117887) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 57012310) |
| Enumeration Date | 2008-06-15 |
| Last Update Date | 2014-10-10 |