| NPI | 1568709657 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RC0000X Internal Medicine, Cardiovascular Disease (Licence: OH 35131382) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: CT 53627) |
| Enumeration Date | 2013-01-09 |
| Last Update Date | 2017-07-14 |