| NPI | 1407045164 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: OH 35-093143) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 35-093143) |
| Enumeration Date | 2007-10-18 |
| Last Update Date | 2016-07-06 |