| NPI | 1366428484 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OH 35060641E) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OH 35060641) |
| Enumeration Date | 2005-12-20 |
| Last Update Date | 2010-01-06 |