| NPI | 1629032925 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OH 35-050671) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 35050671E) |
| Enumeration Date | 2006-04-13 |
| Last Update Date | 2014-05-08 |