| NPI | 1588650113 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OH 35.129350) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: GA 49419) |
| Enumeration Date | 2005-09-20 |
| Last Update Date | 2025-12-30 |