| NPI | 1982713699 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: KY 22022) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 35039319d) |
| Enumeration Date | 2006-08-29 |
| Last Update Date | 2016-04-05 |