| NPI | 1639127806 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NC 200900585) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: NC 200900585) |
| 207R00000X Internal Medicine (Licence: OH 35-067676) | |
| 208000000X Pediatrics (Licence: OH 35-067676) | |
| Enumeration Date | 2006-05-04 |
| Last Update Date | 2021-06-16 |