| NPI | 1265884100 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OH 35.134475) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 57.027608) |
| Enumeration Date | 2016-07-04 |
| Last Update Date | 2020-11-20 |