| NPI | 1285127126 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208D00000X General Practice (Licence: OH 35.150018) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 311531) |
| Enumeration Date | 2018-06-13 |
| Last Update Date | 2025-04-02 |