| NPI | 1104885029 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OH 35-06-3359) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: OH 35-063359) |
| Enumeration Date | 2006-03-20 |
| Last Update Date | 2015-12-03 |