| NPI | 1144889080 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | Yes | 
| Primary Taxonomy | 207RP1001X Internal Medicine, Pulmonary Disease (Licence: OH 35.152736) | 
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 57.248271) | 
| Enumeration Date | 2019-06-12 | 
| Last Update Date | 2025-08-05 |