| NPI | 1184605263 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OH 35 072143) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA G28815) |
| Enumeration Date | 2005-11-07 |
| Last Update Date | 2025-04-15 |