| NPI | 1811946866 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207RA0000X Internal Medicine, Adolescent Medicine (Licence: GA 056302) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 35-066513) |
| Enumeration Date | 2006-05-08 |
| Last Update Date | 2014-04-11 |