| NPI | 1922426113 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MA 273869) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: OH 35-12-9171) |
| 207R00000X Internal Medicine (Licence: MT 74462) | |
| 207R00000X Internal Medicine (Licence: MA 273869) | |
| Enumeration Date | 2014-04-03 |
| Last Update Date | 2023-06-15 |