| NPI | 1447694633 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA A149885) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 57.023101) |
| 208000000X Pediatrics (Licence: OH 57.023101) | |
| 208000000X Pediatrics (Licence: CA A149885) | |
| Enumeration Date | 2013-04-18 |
| Last Update Date | 2017-10-02 |