| NPI | 1538561006 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CT 56786) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 57.024476) |
| Enumeration Date | 2014-09-16 |
| Last Update Date | 2020-12-15 |