| NPI | 1124212865 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NJ 25MB09747200) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: OH 34009546) |
| Enumeration Date | 2007-09-05 |
| Last Update Date | 2016-08-08 |