| NPI | 1083657365 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OH 35.082458) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: OH 35.082458) |
| Enumeration Date | 2006-06-14 |
| Last Update Date | 2021-12-27 |