| NPI | 1083135917 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PA MD487840) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 35.138666) |
| Enumeration Date | 2017-06-30 |
| Last Update Date | 2025-07-24 |