| NPI | 1831779644 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: PA OS025258) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 34.016912) |
| Enumeration Date | 2021-04-14 |
| Last Update Date | 2025-10-20 |