| NPI | 1831297654 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OH 35036925) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WV 10114) |
| 207RH0000X Internal Medicine Hematology (Licence: OH 35036925) | |
| Enumeration Date | 2006-09-20 |
| Last Update Date | 2020-06-05 |