| NPI | 1669551743 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OH 35.088098) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY 210991) |
| Enumeration Date | 2006-11-02 |
| Last Update Date | 2024-06-11 |