| NPI | 1639387236 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OH 35091904) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: OH 35091904) |
| 207R00000X Internal Medicine (Licence: DC MD038167) | |
| 390200000X Student in an Organized Health Care Education/Training Program (Licence: OH TC 57-00-9080) | |
| 208000000X Pediatrics (Licence: DC MD038167) | |
| Enumeration Date | 2007-05-18 |
| Last Update Date | 2009-08-20 |