| NPI | 1114936234 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WV 16211) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 69109) |
| Enumeration Date | 2006-08-07 |
| Last Update Date | 2007-07-08 |