| NPI | 1255520524 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RP1001X Internal Medicine Pulmonary Disease (Licence: OH 35.094060) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 57013071) |
| Enumeration Date | 2007-10-23 |
| Last Update Date | 2014-03-13 |