| NPI | 1922387588 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: KY 57067) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 57019149) |
| Enumeration Date | 2011-08-12 |
| Last Update Date | 2025-04-10 |