| NPI | 1255572863 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: AZ 006512) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 58-003057) |
| Enumeration Date | 2009-03-11 |
| Last Update Date | 2025-11-06 |