| NPI | 1376620625 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OH 35.081971) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NM MD2006-0846) |
| Enumeration Date | 2006-11-01 |
| Last Update Date | 2010-01-16 |