| NPI | 1033194949 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OH 35-06-7799) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: OH 35-06-7799) |
| Enumeration Date | 2005-12-13 |
| Last Update Date | 2018-08-24 |