| NPI | 1124574918 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: RI MD16576) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 57.028668) |
| Enumeration Date | 2016-08-31 |
| Last Update Date | 2023-08-10 |