| NPI | 1437123965 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA C140704) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 35079223P) |
| Enumeration Date | 2006-02-13 |
| Last Update Date | 2017-04-23 |