| NPI | 1992092696 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OH 35.125076) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MT319199) |
| Enumeration Date | 2011-07-01 |
| Last Update Date | 2020-11-05 |