| NPI | 1235139767 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OH 34005237) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: OH 34005237) |
| Enumeration Date | 2005-07-27 |
| Last Update Date | 2020-11-06 |