| NPI | 1639448301 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OH 35-066285) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 135783-1) |
| 207R00000X Internal Medicine (Licence: TX H6814) | |
| Enumeration Date | 2011-12-23 |
| Last Update Date | 2011-12-23 |