| NPI | 1902855562 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OH 35077088S) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: OH 35077088S) |
| Enumeration Date | 2006-05-09 |
| Last Update Date | 2012-09-14 |