| NPI | 1790870798 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OH 35.051269) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 4301046676) |
| Enumeration Date | 2006-10-04 |
| Last Update Date | 2014-10-22 |