| NPI | 1134578479 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OH 34.014426) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: IL 125.068649) |
| 208000000X Pediatrics (Licence: IL 125.068649) | |
| Enumeration Date | 2016-06-07 |
| Last Update Date | 2020-09-13 |