| NPI | 1285059048 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OH 34.013736) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: TN 3807) |
| Enumeration Date | 2014-03-03 |
| Last Update Date | 2020-06-08 |