| NPI | 1912345984 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OH 34.012040) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: VA 0102204375) |
| 207R00000X Internal Medicine (Licence: VA 0102204375) | |
| Enumeration Date | 2013-06-11 |
| Last Update Date | 2020-02-21 |