| NPI | 1154503738 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: OH 35.096866) |
| Additional Taxonomies | 174400000X Specialist (Licence: KY 43929) |
| 174400000X Specialist (Licence: IN 01066317A) | |
| 208000000X Pediatrics (Licence: FL ME153919) | |
| Enumeration Date | 2007-12-05 |
| Last Update Date | 2023-10-19 |