| NPI | 1174754659 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MI 5101019422) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 34.011644) |
| Enumeration Date | 2009-08-02 |
| Last Update Date | 2020-12-29 |