| NPI | 1497310015 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OH 58.030800) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WV 4708) |
| Enumeration Date | 2019-05-08 |
| Last Update Date | 2025-12-01 |