| NPI | 1750588232 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: VA 0102202610) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 34-009611) |
| Enumeration Date | 2007-06-28 |
| Last Update Date | 2025-09-09 |