| NPI | 1871643387 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WV 15735) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 35060560) |
| Enumeration Date | 2007-01-10 |
| Last Update Date | 2012-10-09 |