| NPI | 1720564131 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OH 35.140242) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 57.245594) |
| Enumeration Date | 2018-07-18 |
| Last Update Date | 2021-08-02 |