| NPI | 1083881486 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA G21860) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 35.032356) |
| Enumeration Date | 2008-05-14 |
| Last Update Date | 2008-05-14 |