| NPI | 1053677781 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: OH 35.132884) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: PA MD454163) |
| Enumeration Date | 2012-04-06 |
| Last Update Date | 2021-04-09 |