| NPI | 1790179232 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208M00000X Hospitalist (Licence: OH 35136270) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 35136270) |
| 208000000X Pediatrics (Licence: OH 35136270) | |
| Enumeration Date | 2015-03-23 |
| Last Update Date | 2019-04-17 |