| NPI | 1518616986 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OH 35.152148) |
| Additional Taxonomies | 208D00000X General Practice (Licence: FL ME165666) |
| Enumeration Date | 2022-03-22 |
| Last Update Date | 2025-08-05 |