| NPI | 1497739171 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OH 350-45513) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 35045513) |
| Enumeration Date | 2005-12-06 |
| Last Update Date | 2021-01-05 |