| NPI | 1578876363 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NC 2014-00279) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 57.015812) |
| 207R00000X Internal Medicine (Licence: OH 098386) | |
| Enumeration Date | 2010-07-21 |
| Last Update Date | 2021-02-16 |