| NPI | 1154595973 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: OH 35.094947) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: OH 57013786) |
| Enumeration Date | 2008-04-14 |
| Last Update Date | 2013-08-13 |