| NPI | 1013203827 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MN 74120) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 35.137259) |
| Enumeration Date | 2011-06-21 |
| Last Update Date | 2024-04-17 |