| NPI | 1699844704 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OH 34004374) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: KY 02229) |
| Enumeration Date | 2006-11-06 |
| Last Update Date | 2012-04-18 |