| NPI | 1205327897 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OH 34.015342) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CA 20887) |
| Enumeration Date | 2018-05-20 |
| Last Update Date | 2025-06-11 |