| NPI | 1124402383 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OH 35133121) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IN 01085779A) |
| Enumeration Date | 2015-07-16 |
| Last Update Date | 2025-09-08 |