| NPI | 1649333071 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OH 35.093146) |
| Additional Taxonomies | 174400000X Specialist (Licence: IN 01063082A) |
| Enumeration Date | 2006-12-18 |
| Last Update Date | 2021-04-19 |