| NPI | 1225071368 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | Yes | 
| Primary Taxonomy | 207RN0300X Internal Medicine, Nephrology (Licence: OH 35062517)  | 
| Additional Taxonomies | 207RN0300X Internal Medicine, Nephrology (Licence: KY 28464)  | 
| Enumeration Date | 2006-06-14 | 
| Last Update Date | 2011-11-01 |