| NPI | 1467019455 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: VA 0101276694) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 35.146387) |
| Enumeration Date | 2019-05-24 |
| Last Update Date | 2023-12-19 |