| NPI | 1235491275 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OH 57.020641) |
| Additional Taxonomies | 207K00000X Allergy & Immunology (Licence: OH 35.125375) |
| Enumeration Date | 2012-06-14 |
| Last Update Date | 2025-03-04 |