| NPI | 1184004541 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MI 5101024424) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 34.013034) |
| Enumeration Date | 2015-06-01 |
| Last Update Date | 2025-10-10 |