| NPI | 1972856250 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: DE C1-0024205) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 57.021646) |
| Enumeration Date | 2012-10-24 |
| Last Update Date | 2022-09-02 |