| NPI | 1093378267 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OH 57.250597) |
| Additional Taxonomies | 208600000X Surgery (Licence: AZ R77377) |
| Enumeration Date | 2019-04-15 |
| Last Update Date | 2021-07-31 |