| NPI | 1144280157 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OH 34.009974) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WV 1117) |
| Enumeration Date | 2006-03-24 |
| Last Update Date | 2020-12-11 |