| NPI | 1437728896 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MI 4301511615) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 35.156130) |
| Enumeration Date | 2021-06-21 |
| Last Update Date | 2026-05-13 |