| NPI | 1144283086 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WV 09304) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 35062608) |
| Enumeration Date | 2006-04-11 |
| Last Update Date | 2007-10-23 |