| NPI | 1619557923 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OH 35.151730) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 4301511218) |
| Enumeration Date | 2021-04-11 |
| Last Update Date | 2026-05-29 |