| NPI | 1558438846 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NM MD2007-0018) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 35.087635) |
| Enumeration Date | 2006-11-29 |
| Last Update Date | 2019-06-10 |