| NPI | 1124067483 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IN 01082267A) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 35-034227) |
| Enumeration Date | 2006-06-05 |
| Last Update Date | 2019-10-14 |