| NPI | 1154336634 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OH 35088264) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 4301075997) |
| Enumeration Date | 2006-07-31 |
| Last Update Date | 2011-01-11 |