| NPI | 1073581088 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: VA 101270294) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: OH 35.086957) |
| 208000000X Pediatrics (Licence: MD D64655) | |
| Enumeration Date | 2006-03-08 |
| Last Update Date | 2020-10-25 |