| NPI | 1750350559 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OH 34-00-8658) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: OH 34-00-8658) |
| Enumeration Date | 2006-03-15 |
| Last Update Date | 2025-06-20 |