| NPI | 1992891972 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OH 35-094289) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MO T2005021696) |
| Enumeration Date | 2006-10-05 |
| Last Update Date | 2010-04-29 |