| NPI | 1831571009 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IN 02008144A) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 34.014054) |
| 207R00000X Internal Medicine (Licence: KY 05660) | |
| 207R00000X Internal Medicine (Licence: TX BP10053241) | |
| Enumeration Date | 2015-06-24 |
| Last Update Date | 2025-01-16 |