| NPI | 1306473533 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OH 35.150786) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 57.249239) |
| 208000000X Pediatrics (Licence: OH 57.249239) | |
| 208000000X Pediatrics (Licence: OH 35.150786) | |
| Enumeration Date | 2020-03-26 |
| Last Update Date | 2024-06-25 |