| NPI | 1033526603 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: OH 35.138744) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: WI 67591) |
| Enumeration Date | 2014-07-16 |
| Last Update Date | 2021-02-03 |