| NPI | 1598926529 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OH 35120109) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: SC 30889) |
| Enumeration Date | 2008-06-23 |
| Last Update Date | 2012-10-18 |