| NPI | 1275648123 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MI 4301046178) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL ME 91109) |
| 207R00000X Internal Medicine (Licence: GA 052622) | |
| 207R00000X Internal Medicine (Licence: ID M-9253) | |
| 207R00000X Internal Medicine (Licence: IL 036-097074) | |
| 207R00000X Internal Medicine (Licence: MO 2003003395) | |
| 207R00000X Internal Medicine (Licence: OH 35-07-2106-P) | |
| Enumeration Date | 2006-08-20 |
| Last Update Date | 2007-07-08 |