| NPI | 1588118020 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OH 35.145617) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 4301109913) |
| 207R00000X Internal Medicine (Licence: MO 2019024769) | |
| Enumeration Date | 2016-08-13 |
| Last Update Date | 2025-04-01 |