| NPI | 1770582686 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OH 77830) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MI 4301114379) |
| 207R00000X Internal Medicine (Licence: OH 35-07-7830) | |
| 208000000X Pediatrics (Licence: OH 35-07-7830) | |
| Enumeration Date | 2005-07-21 |
| Last Update Date | 2020-09-04 |