| NPI | 1073717948 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: TX U5004) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: OH 35-080545) |
| Enumeration Date | 2007-06-13 |
| Last Update Date | 2023-10-03 |