| NPI | 1104897594 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OH 35-063290) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 63290) |
| Enumeration Date | 2006-02-01 |
| Last Update Date | 2011-02-14 |