| NPI | 1679839294 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: OH 35.123583) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 35123583) |
| 2080P0204X Pediatrics, Pediatric Emergency Medicine (Licence: OH 35-123583) | |
| Enumeration Date | 2012-04-09 |
| Last Update Date | 2022-03-15 |