| NPI | 1780775346 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: DC MD034243) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MD D0057495) |
| 207R00000X Internal Medicine (Licence: IL 036-105737) | |
| 207R00000X Internal Medicine (Licence: OH 35-08-2149-0) | |
| Enumeration Date | 2006-09-27 |
| Last Update Date | 2007-07-08 |