| NPI | 1730235797 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL OS9185) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 34.008213) |
| 207R00000X Internal Medicine (Licence: CA 20A 9382) | |
| Enumeration Date | 2007-01-25 |
| Last Update Date | 2013-07-03 |