| NPI | 1861076556 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OH 35.155609) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: PA MD484342) |
| Enumeration Date | 2021-05-08 |
| Last Update Date | 2026-07-30 |