| NPI | 1295256618 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: KS 04-52422) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 57.029864) |
| Enumeration Date | 2017-07-06 |
| Last Update Date | 2026-04-23 |