| NPI | 1710900790 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OH 3504259) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 35042059K) |
| Enumeration Date | 2006-07-25 |
| Last Update Date | 2011-05-04 |