| NPI | 1942224274 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OH 35.144893) |
| Additional Taxonomies | 207R00000X Internal Medicine (Licence: MS 26631) |
| 207R00000X Internal Medicine (Licence: NC 200400172) | |
| 207R00000X Internal Medicine (Licence: VA 0101-240922) | |
| 208000000X Pediatrics (Licence: NC 200400172) | |
| 208000000X Pediatrics (Licence: VA 0101-240922) | |
| Enumeration Date | 2006-07-27 |
| Last Update Date | 2022-05-02 |