| NPI | 1104923762 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RA0000X Internal Medicine, Adolescent Medicine (Licence: OH 35069486) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 35069486M) |
| 208000000X Pediatrics (Licence: OH 35069486M) | |
| Enumeration Date | 2006-09-17 |
| Last Update Date | 2021-12-27 |