| NPI | 1063703965 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OH 35.123163) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 57-01-7490) |
| Enumeration Date | 2011-04-26 |
| Last Update Date | 2014-12-16 |