| NPI | 1962631051 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PA MD446214) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 57-015946) |
| Enumeration Date | 2009-07-09 |
| Last Update Date | 2016-12-09 |