| NPI | 1386098994 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: AZ 58391) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 57.027632) |
| Enumeration Date | 2016-04-20 |
| Last Update Date | 2019-06-26 |