| NPI | 1689794125 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA A105508) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 35.091793) |
| Enumeration Date | 2007-03-29 |
| Last Update Date | 2011-04-27 |