| NPI | 1730344029 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MI 4301097669) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 35.096537) |
| Enumeration Date | 2008-07-25 |
| Last Update Date | 2023-05-17 |