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 |