| NPI | 1033172812 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: OH 35-085354) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NY 1960141) |
| Enumeration Date | 2006-04-11 |
| Last Update Date | 2023-03-07 |