| NPI | 1568409852 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OH 35.086453) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX Temporary) |
| Enumeration Date | 2006-06-02 |
| Last Update Date | 2008-11-21 |