| NPI | 1669438917 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: KY 36728) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 35073385D) |
| 208000000X Pediatrics (Licence: KY 36728) | |
| 208000000X Pediatrics (Licence: OH 35073385D) | |
| Enumeration Date | 2006-04-25 |
| Last Update Date | 2024-04-30 |