| NPI | 1649388604 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OH 34. 008596) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OH 34008596) |
| 207R00000X Internal Medicine (Licence: WV 2136) | |
| Enumeration Date | 2006-08-29 |
| Last Update Date | 2022-03-29 |