| NPI | 1790273761 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OH 35.144411) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 39) |
| Enumeration Date | 2018-04-25 |
| Last Update Date | 2024-08-15 |