| NPI | 1093920928 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: CA A136758) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: OH 57.010495) |
| Enumeration Date | 2007-05-14 |
| Last Update Date | 2016-12-28 |