| NPI | 1346620564 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IN 01087704A) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 57.025883) |
| Enumeration Date | 2015-06-03 |
| Last Update Date | 2022-08-19 |