NPI | 1952421638 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 207R00000X Internal Medicine (Licence: OH 34-008773) |
Additional Taxonomies | 261Q00000X Clinic/Center (Licence: OH 58-001453) |
Enumeration Date | 2007-03-29 |
Last Update Date | 2022-07-21 |