| NPI | 1366412926 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: WV 20459) |
| Additional Taxonomies | 207Q00000X Family Medicine (Licence: WV 20459) |
| 207R00000X Internal Medicine (Licence: WV 20459) | |
| 207R00000X Internal Medicine (Licence: OH 35075810) | |
| Enumeration Date | 2006-01-25 |
| Last Update Date | 2021-06-17 |