| NPI | 1619116878 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WI 41205) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 46934) |
| 207R00000X Internal Medicine (Licence: IL 074890) | |
| Enumeration Date | 2009-02-11 |
| Last Update Date | 2009-02-11 |