| NPI | 1649461872 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA A106448) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 35.089805) |
| Enumeration Date | 2007-08-05 |
| Last Update Date | 2010-02-01 |