| NPI | 1548365034 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA C 53216) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 35-065443) |
| Enumeration Date | 2006-09-13 |
| Last Update Date | 2014-12-09 |