| NPI | 1003030750 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: MI 4301095940) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 88272) |
| 208000000X Pediatrics (Licence: OH 88272) | |
| Enumeration Date | 2007-04-12 |
| Last Update Date | 2017-05-02 |