| NPI | 1730684044 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OH 57.245469) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: OH 57.245469) |
| Enumeration Date | 2018-03-28 |
| Last Update Date | 2022-06-24 |