| NPI | 1649414525 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: AR E-18802) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: AR E-18802) |
| 208000000X Pediatrics (Licence: OH 35.121001) | |
| 207R00000X Internal Medicine (Licence: OH 35.121001) | |
| Enumeration Date | 2009-04-23 |
| Last Update Date | 2025-12-04 |