| NPI | 1649702259 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207RC0000X Internal Medicine, Cardiovascular Disease (Licence: CA 173057) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 57.030483) |
| Enumeration Date | 2017-04-02 |
| Last Update Date | 2021-06-29 |