| NPI | 1568878379 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OH 57.024465) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WA MD60703673) |
| Enumeration Date | 2014-07-02 |
| Last Update Date | 2025-10-01 |