| 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 | 2025-11-12 |