| NPI | 1528697570 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: CA A207242) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 35.150794) |
| 208000000X Pediatrics (Licence: CA A207242) | |
| Enumeration Date | 2020-04-02 |
| Last Update Date | 2026-08-03 |