| NPI | 1376705483 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OH 35095119) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: OH 35095119) |
| 208000000X Pediatrics (Licence: CA A127233) | |
| 207R00000X Internal Medicine (Licence: CA A127233) | |
| Enumeration Date | 2008-06-30 |
| Last Update Date | 2015-09-15 |