| NPI | 1083875421 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: LA 309479) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: OH 35095078) |
| Enumeration Date | 2008-06-18 |
| Last Update Date | 2018-10-08 |