| NPI | 1609866490 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OH 35084467) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 35-084467) |
| Enumeration Date | 2005-10-24 |
| Last Update Date | 2012-01-04 |