| NPI | 1861844201 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IL 036.163331) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 35.134912) |
| Enumeration Date | 2016-07-11 |
| Last Update Date | 2023-03-27 |