| NPI | 1205288610 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OH 35.134945) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 57.028015) |
| Enumeration Date | 2016-07-09 |
| Last Update Date | 2021-12-22 |