| NPI | 1003426412 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: AR E-16928) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: OH 57.248860) |
| Enumeration Date | 2020-07-31 |
| Last Update Date | 2024-10-09 |