| NPI | 1245736115 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IN 01086944A) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: KS 04-51185) |
| 207R00000X Internal Medicine (Licence: OH 35.142899) | |
| Enumeration Date | 2018-03-31 |
| Last Update Date | 2025-06-19 |