| NPI | 1972726123 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: OH 35122280) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: IN 01062565A) |
| 208000000X Pediatrics (Licence: OH 35122280) | |
| Enumeration Date | 2007-04-10 |
| Last Update Date | 2024-11-05 |