| NPI | 1760793897 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: VA 0101254930) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 35.130138) |
| Enumeration Date | 2010-06-23 |
| Last Update Date | 2021-10-04 |