| NPI | 1770584591 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OH 35071467K) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 35071467) |
| Enumeration Date | 2005-08-02 |
| Last Update Date | 2010-09-03 |