| NPI | 1740286467 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OK 18853) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 35067408M) |
| Enumeration Date | 2005-06-27 |
| Last Update Date | 2012-05-17 |