| NPI | 1154852861 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: KY R4440) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 35.139101) |
| Enumeration Date | 2017-03-23 |
| Last Update Date | 2021-01-21 |