| NPI | 1679914493 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PA OS018160) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 58.005283) |
| Enumeration Date | 2013-07-09 |
| Last Update Date | 2018-03-17 |