| NPI | 1114063567 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080P0201X Pediatrics, Pediatric Allergy/Immunology (Licence: OH 35057552M) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: OH 35057552M) |
| Enumeration Date | 2007-01-30 |
| Last Update Date | 2021-11-03 |