| NPI | 1356914303 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MI 5101029043) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 34.018323) |
| Enumeration Date | 2021-07-19 |
| Last Update Date | 2026-04-09 |