| NPI | 1588010649 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OH 34.013770) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WV 3350) |
| Enumeration Date | 2016-05-09 |
| Last Update Date | 2021-10-28 |