| NPI | 1790277143 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OH 34.016227) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA OT018837) |
| Enumeration Date | 2018-06-01 |
| Last Update Date | 2024-04-22 |