| NPI | 1144510231 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: KY 48156) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 53.019336) |
| 208000000X Pediatrics (Licence: OH 53.019336) | |
| 208000000X Pediatrics (Licence: KY 48156) | |
| Enumeration Date | 2011-04-11 |
| Last Update Date | 2018-09-07 |