| NPI | 1245727270 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MA 291159) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 35.140815) |
| Enumeration Date | 2018-04-16 |
| Last Update Date | 2022-06-27 |