| NPI | 1699037382 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OH 35.099279) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NJ 25MA09195700) |
| Enumeration Date | 2012-06-09 |
| Last Update Date | 2013-04-19 |