| NPI | 1871574780 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OH 35058585) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 35058585M) |
| Enumeration Date | 2005-11-08 |
| Last Update Date | 2014-04-02 |