| NPI | 1255836698 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MI 4301507368) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 35.141569) |
| Enumeration Date | 2018-03-28 |
| Last Update Date | 2025-10-06 |