| NPI | 1063832079 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OH 28260) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 30-28260) |
| Enumeration Date | 2014-04-17 |
| Last Update Date | 2014-04-17 |