| NPI | 1700110822 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IN 01071713A) |
| Additional Taxonomies | 172A00000X Driver (Licence: NY 698511379) |
| 207R00000X Internal Medicine (Licence: IL 130000832) | |
| 207R00000X Internal Medicine (Licence: MA 242129) | |
| 207R00000X Internal Medicine (Licence: MI 4301104116) | |
| 207R00000X Internal Medicine (Licence: OH 35.121160) | |
| Enumeration Date | 2009-09-22 |
| Last Update Date | 2020-01-15 |