| NPI | 1609865195 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RP1001X Internal Medicine, Pulmonary Disease (Licence: NY 268699) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 35085862) |
| 207L00000X Anesthesiology (Licence: OH 35.085862) | |
| 2084N0008X Psychiatry & Neurology, Neuromuscular Medicine (Licence: OH 35.085862) | |
| 2084N0400X Psychiatry & Neurology, Neurology (Licence: OH 35.085862) | |
| Enumeration Date | 2005-10-18 |
| Last Update Date | 2015-10-01 |