| NPI | 1750572574 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PA OS014613) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH AC8252809069) |
| 207R00000X Internal Medicine (Licence: NY 259319) | |
| Enumeration Date | 2007-08-06 |
| Last Update Date | 2017-06-13 |