| NPI | 1417246729 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OH 35132517) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 57.019741) |
| Enumeration Date | 2011-04-07 |
| Last Update Date | 2018-08-08 |