| NPI | 1174180608 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OH 35.144238) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: RI LP04519) |
| Enumeration Date | 2019-05-21 |
| Last Update Date | 2022-06-15 |