| NPI | 1730517061 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IN 01084433A) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 127339) |
| Enumeration Date | 2013-10-23 |
| Last Update Date | 2020-08-17 |