| NPI | 1720569015 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: LA 329908) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 57245831) |
| Enumeration Date | 2018-08-24 |
| Last Update Date | 2025-05-06 |