| NPI | 1083710370 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OH 35-064135) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 35.064135) |
| Enumeration Date | 2006-09-15 |
| Last Update Date | 2011-04-06 |