| NPI | 1104132554 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL TRN15225) |
| Additional Taxonomies | 207RR0500X Internal Medicine, Rheumatology (Licence: OH 57.022470) |
| Enumeration Date | 2010-08-24 |
| Last Update Date | 2014-01-09 |