| NPI | 1487115739 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MD D98788) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 35.144554) |
| Enumeration Date | 2019-03-28 |
| Last Update Date | 2025-03-18 |