| NPI | 1447291745 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OH 34.010931) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL OS 10714) |
| Enumeration Date | 2006-06-09 |
| Last Update Date | 2020-07-31 |