| NPI | 1669456422 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WI 82456) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: OH 35075026) |
| 207R00000X Internal Medicine (Licence: OH 35075026) | |
| 208000000X Pediatrics (Licence: WI 82456) | |
| Enumeration Date | 2005-12-05 |
| Last Update Date | 2023-08-08 |