| NPI | 1194163089 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OH 34.012200) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 5101020623) |
| Enumeration Date | 2013-06-13 |
| Last Update Date | 2023-11-03 |