| NPI | 1457093676 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: KY TP615) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 57.253212) |
| 207R00000X Internal Medicine (Licence: OH 35.154617) | |
| Enumeration Date | 2022-04-08 |
| Last Update Date | 2025-09-10 |