| NPI | 1174792923 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OH 35127471) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 4301084394) |
| 208000000X Pediatrics (Licence: MI 4301084394) | |
| Enumeration Date | 2008-02-26 |
| Last Update Date | 2021-08-02 |