| NPI | 1255595807 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: KY 49102) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: KY 49102) |
| 207R00000X Internal Medicine (Licence: MI 4301092599) | |
| 208000000X Pediatrics (Licence: MI 4301092599) | |
| 207R00000X Internal Medicine (Licence: OH 35 128851) | |
| 208000000X Pediatrics (Licence: OH 35 128851) | |
| Enumeration Date | 2008-07-14 |
| Last Update Date | 2016-08-25 |