| NPI | 1023218484 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MD D0086812) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 35.094889) |
| Enumeration Date | 2007-07-23 |
| Last Update Date | 2023-05-14 |