| NPI | 1609017219 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RC0000X Internal Medicine, Cardiovascular Disease (Licence: OH 35121892) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MA 229570) |
| Enumeration Date | 2009-03-11 |
| Last Update Date | 2017-04-07 |