| NPI | 1689784266 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OH 35.064211) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IA 23745) |
| 207R00000X Internal Medicine (Licence: IN 01041082A) | |
| 207R00000X Internal Medicine (Licence: NJ 25MA04638800) | |
| Enumeration Date | 2006-08-30 |
| Last Update Date | 2023-09-07 |