| NPI | 1619067147 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IN 01061603A) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 35.087590) |
| Enumeration Date | 2006-10-13 |
| Last Update Date | 2011-05-04 |