| NPI | 1245736115 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IN 01086944A) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 35.142899) |
| Enumeration Date | 2018-03-31 |
| Last Update Date | 2023-10-20 |