| NPI | 1053341370 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: OH 35-05-4754) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: WV 16987) |
| Enumeration Date | 2006-07-03 |
| Last Update Date | 2020-12-29 |