| NPI | 1780493429 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: OH 57.260201) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NY P133266) |
| Enumeration Date | 2025-01-07 |
| Last Update Date | 2026-04-28 |