| NPI | 1952715666 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OH 34.012021) |
| Additional Taxonomies | 171000000X Military Health Care Provider (Licence: OH 34.012.021) |
| Enumeration Date | 2014-06-20 |
| Last Update Date | 2023-09-20 |