| NPI | 1568716629 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NY 301021) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 57.021861) |
| Enumeration Date | 2012-10-28 |
| Last Update Date | 2019-10-16 |