| NPI | 1295471753 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: GA 111634) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 57.523313) |
| Enumeration Date | 2022-05-09 |
| Last Update Date | 2026-09-16 |