| NPI | 1902989502 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NY 231092) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 34.009711) |
| Enumeration Date | 2006-10-24 |
| Last Update Date | 2013-01-17 |