| NPI | 1043345309 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: CO DR.0055277) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: OH 35123774) |
| 2080A0000X Pediatrics, Adolescent Medicine (Licence: OH 35123774) | |
| Enumeration Date | 2007-02-23 |
| Last Update Date | 2020-02-18 |