| NPI | 1164509964 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OH 35-091775) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WV 20619) |
| Enumeration Date | 2006-11-01 |
| Last Update Date | 2009-02-04 |