| NPI | 1194956573 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MA 252381) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 099419) |
| Enumeration Date | 2009-08-03 |
| Last Update Date | 2012-08-14 |