| NPI | 1649530668 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OH 35.138164) |
| Additional Taxonomies | 208600000X Surgery (Licence: FL 17206) |
| Enumeration Date | 2012-05-23 |
| Last Update Date | 2020-01-15 |