| NPI | 1851787410 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OH 35.129912) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: OH 35.129912) |
| Enumeration Date | 2015-04-10 |
| Last Update Date | 2022-12-29 |