| NPI | 1396784963 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: OH 35-081138) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 35-081138) |
| Enumeration Date | 2006-06-06 |
| Last Update Date | 2025-04-07 |