| NPI | 1588195713 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: IL 036161413) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 35140724) |
| 208000000X Pediatrics (Licence: OH 35140724) | |
| 2080P0204X Pediatrics, Pediatric Emergency Medicine (Licence: OH 35140724) | |
| Enumeration Date | 2017-03-21 |
| Last Update Date | 2022-08-30 |