| NPI | 1396021770 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OH 35.130715) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: ME MD19979) |
| Enumeration Date | 2011-10-28 |
| Last Update Date | 2022-07-21 |