| NPI | 1629152137 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NC 2003-00476) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 35034131) |
| Enumeration Date | 2006-10-24 |
| Last Update Date | 2007-07-08 |