| NPI | 1528325644 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OH 35.126869) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: FL ME162687) |
| Enumeration Date | 2012-04-13 |
| Last Update Date | 2025-11-21 |