| NPI | 1104183904 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: OH 35144830) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: CA A127321) |
| Enumeration Date | 2012-04-18 |
| Last Update Date | 2022-05-12 |