| NPI | 1619917705 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: OH 35-079953) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 35-079953) |
| Enumeration Date | 2006-06-07 |
| Last Update Date | 2023-10-16 |