| NPI | 1457369027 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: KY 32196) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 35.128598) |
| Enumeration Date | 2006-08-03 |
| Last Update Date | 2024-12-06 |