| NPI | 1972115277 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OH 35.147764) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 57249623) |
| Enumeration Date | 2020-08-18 |
| Last Update Date | 2023-06-23 |