| NPI | 1285759449 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OH 35092185) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 57.010433) |
| Enumeration Date | 2007-03-20 |
| Last Update Date | 2011-10-13 |