| NPI | 1386095560 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OH 57.027544) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 35.132370) |
| Enumeration Date | 2016-06-28 |
| Last Update Date | 2018-03-05 |