| NPI | 1154944031 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OH 35.148422) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 57.249590) |
| Enumeration Date | 2020-05-26 |
| Last Update Date | 2023-12-11 |