| NPI | 1619298379 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OH 35123567) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: RI MD17008) |
| 208000000X Pediatrics (Licence: MA 244515) | |
| Enumeration Date | 2010-06-17 |
| Last Update Date | 2020-03-16 |