| NPI | 1295484517 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA A208732) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: CA A208732) |
| 207R00000X Internal Medicine (Licence: OH 57.252461) | |
| 208000000X Pediatrics (Licence: OH 57.252461) | |
| Enumeration Date | 2022-03-23 |
| Last Update Date | 2026-09-01 |