| NPI | 1154559177 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MI 4301110989) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: OH 35.099525) |
| Enumeration Date | 2009-06-29 |
| Last Update Date | 2019-12-09 |