| NPI | 1689865651 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NC 200701688) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 34.009066) |
| Enumeration Date | 2007-08-06 |
| Last Update Date | 2008-02-20 |