| NPI | 1285296715 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: KY 60404) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 125073914) |
| 207R00000X Internal Medicine (Licence: OH 35.149143) | |
| Enumeration Date | 2019-07-04 |
| Last Update Date | 2025-06-27 |