| NPI | 1316143639 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: TX Q1071) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 52400) |
| 208000000X Pediatrics (Licence: OH 52400) | |
| Enumeration Date | 2007-06-23 |
| Last Update Date | 2019-02-27 |