| NPI | 1437592383 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OR DO190594) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 34012220) |
| Enumeration Date | 2013-04-10 |
| Last Update Date | 2025-04-01 |