| NPI | 1487850996 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OH 35.096920) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: OH 35.096920) |
| Enumeration Date | 2007-06-22 |
| Last Update Date | 2021-12-20 |