| NPI | 1801891692 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IN 01095964A) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 35079855) |
| Enumeration Date | 2005-06-17 |
| Last Update Date | 2025-05-28 |