| NPI | 1942276613 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WI 54875-20) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 35084303A) |
| 207R00000X Internal Medicine (Licence: NC 2010-01667) | |
| Enumeration Date | 2006-02-23 |
| Last Update Date | 2011-04-07 |