| NPI | 1851396840 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME164761) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 35064619) |
| 207R00000X Internal Medicine (Licence: OH 35064619L) | |
| Enumeration Date | 2005-06-16 |
| Last Update Date | 2025-07-24 |