| NPI | 1104170273 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MO 2025007514) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 35.126924) |
| 207R00000X Internal Medicine (Licence: OH 57.022113) | |
| 207R00000X Internal Medicine (Licence: KS 04-41333) | |
| Enumeration Date | 2012-10-29 |
| Last Update Date | 2025-08-27 |