| NPI | 1508862244 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OH 35.081534) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TX N6823) |
| 207R00000X Internal Medicine (Licence: IN 01068901A) | |
| 207R00000X Internal Medicine (Licence: KY 48113) | |
| Enumeration Date | 2005-06-27 |
| Last Update Date | 2016-02-18 |