| NPI | 1306944673 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OH 35042906C) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: KY 23202) |
| Enumeration Date | 2006-09-20 |
| Last Update Date | 2009-08-10 |