| NPI | 1710265707 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MD D88305) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 123754) |
| Enumeration Date | 2011-07-26 |
| Last Update Date | 2020-05-11 |