| NPI | 1740423250 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NV 13723) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 35-092920) |
| Enumeration Date | 2009-04-14 |
| Last Update Date | 2024-04-10 |