| NPI | 1750814562 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NY 322626) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 34.016188) |
| Enumeration Date | 2017-04-07 |
| Last Update Date | 2023-11-20 |