| NPI | 1083829923 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OH 35.142798) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: WV 24030) |
| 208000000X Pediatrics (Licence: WV 24030) | |
| 208000000X Pediatrics (Licence: OH 35.142798) | |
| Enumeration Date | 2007-05-14 |
| Last Update Date | 2021-08-17 |