| NPI | 1508228081 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OH 35.136182) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 125069050) |
| Enumeration Date | 2016-03-24 |
| Last Update Date | 2019-04-29 |