| NPI | 1770618688 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OH 35.088775) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 35088775) |
| Enumeration Date | 2007-02-22 |
| Last Update Date | 2022-03-04 |