| NPI | 1053524421 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MI 4301095310) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: OH 57009054) |
| 208000000X Pediatrics (Licence: OH 35089753) | |
| 208000000X Pediatrics (Licence: TN MD53314) | |
| Enumeration Date | 2007-05-08 |
| Last Update Date | 2025-12-11 |