| NPI | 1679539522 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: WV 21594) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 35.134827) |
| 208000000X Pediatrics (Licence: WV 21594) | |
| 208000000X Pediatrics (Licence: OH 35.134827) | |
| Enumeration Date | 2006-04-20 |
| Last Update Date | 2024-09-18 |