| NPI | 1154483089 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: OH 069707) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MI 059637) |
| Enumeration Date | 2006-12-15 |
| Last Update Date | 2023-03-07 |