| NPI | 1770739310 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: DC MD045718) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MD434797) |
| 207R00000X Internal Medicine (Licence: OH 35-093924) | |
| Enumeration Date | 2008-08-14 |
| Last Update Date | 2018-01-10 |