| NPI | 1154364677 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: OH 35054710) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: OH 35054710H) |
| Enumeration Date | 2006-06-13 |
| Last Update Date | 2021-01-25 |