| NPI | 1750647798 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: FL ME137139) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 35.126630) |
| 208000000X Pediatrics (Licence: OH 35.126630) | |
| Enumeration Date | 2012-04-04 |
| Last Update Date | 2017-09-27 |