| NPI | 1861933574 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MI 5101027606) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 34.014339) |
| Enumeration Date | 2017-03-14 |
| Last Update Date | 2023-08-28 |