| NPI | 1073134854 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OH 35.155327) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: OH 35.155327) |
| 208D00000X General Practice (Licence: OH 35.155327) | |
| Enumeration Date | 2020-05-03 |
| Last Update Date | 2026-04-20 |