| NPI | 1063563476 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MI 4301073850) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: OH 35.084012) |
| Enumeration Date | 2007-01-13 |
| Last Update Date | 2024-07-09 |