| NPI | 1396049011 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RC0000X Internal Medicine, Cardiovascular Disease (Licence: OH 34010728) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 34010728) |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: OH 58.003689) | |
| Enumeration Date | 2011-01-10 |
| Last Update Date | 2021-01-28 |