| NPI | 1689234155 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WI 103051-875) |
| Additional Taxonomies | 207P00000X Emergency Medicine (Licence: OH 35.145713) |
| Enumeration Date | 2019-06-17 |
| Last Update Date | 2025-08-27 |