| NPI | 1730601956 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OH 35.141097) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 57.029858) |
| Enumeration Date | 2017-07-10 |
| Last Update Date | 2022-07-21 |