| NPI | 1942794680 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IL 036164004) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 57.246216) |
| Enumeration Date | 2018-06-16 |
| Last Update Date | 2023-06-01 |