| NPI | 1730185844 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OH 35.055488) |
| Additional Taxonomies | 207RS0010X Internal Medicine, Sports Medicine (Licence: OH 35.055488) |
| Enumeration Date | 2005-06-23 |
| Last Update Date | 2013-07-30 |