| NPI | 1871509752 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA A83131) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 35.081899) |
| 207R00000X Internal Medicine (Licence: KY 38164) | |
| Enumeration Date | 2006-07-31 |
| Last Update Date | 2007-09-06 |