| NPI | 1689967911 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: VA 0101253756) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 57.017388) |
| Enumeration Date | 2011-05-19 |
| Last Update Date | 2024-04-30 |