| NPI | 1255580585 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WV 2269) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 58.002059) |
| Enumeration Date | 2008-09-10 |
| Last Update Date | 2009-06-22 |