| NPI | 1558927749 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MO 2025015710) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 35.145561) |
| Enumeration Date | 2019-05-14 |
| Last Update Date | 2025-08-19 |