| NPI | 1235875725 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IL 036176783) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 57253193) |
| Enumeration Date | 2022-05-09 |
| Last Update Date | 2025-10-02 |