| NPI | 1760429740 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TN MD41434) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 35.086268) |
| Enumeration Date | 2006-05-31 |
| Last Update Date | 2010-11-08 |