| NPI | 1871507608 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NC 2009-00333) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: VA 0101243068) |
| 207R00000X Internal Medicine (Licence: OH 35.085508) | |
| Enumeration Date | 2006-07-28 |
| Last Update Date | 2018-12-20 |