| NPI | 1295212025 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OH 35.140229) |
| Additional Taxonomies | 207RC0000X Internal Medicine, Cardiovascular Disease (Licence: OH 35.140229) |
| 207R00000X Internal Medicine (Licence: OH 57.245537) | |
| 282N00000X General Acute Care Hospital (Licence: OH 35.140229) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: OH 35.140229) | |
| Enumeration Date | 2018-07-24 |
| Last Update Date | 2025-09-24 |