| NPI | 1699098806 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NY 293771) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 35130708) |
| Enumeration Date | 2010-03-03 |
| Last Update Date | 2018-06-20 |