| NPI | 1346466299 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IL 036.122290) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 35.089004) |
| Enumeration Date | 2007-04-18 |
| Last Update Date | 2021-01-27 |