| NPI | 1194222422 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA 193556) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MO 2021025589) |
| 207R00000X Internal Medicine (Licence: OH 57.246123) | |
| Enumeration Date | 2018-04-12 |
| Last Update Date | 2026-08-14 |