| NPI | 1255378857 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OH 35087989) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 225561) |
| Enumeration Date | 2006-06-01 |
| Last Update Date | 2007-07-08 |