| NPI | 1255317004 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OH 35070697M) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WV 18659) |
| Enumeration Date | 2005-12-22 |
| Last Update Date | 2007-07-08 |