| NPI | 1346772894 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IN 01089309A) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 35141241) |
| 207R00000X Internal Medicine (Licence: ID 5471553) | |
| 207R00000X Internal Medicine (Licence: MO 2024006031) | |
| 207R00000X Internal Medicine (Licence: MA 283468) | |
| Enumeration Date | 2017-04-03 |
| Last Update Date | 2026-07-30 |