| NPI | 1164426995 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: OH 35.081189) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: OH 35-08-1189 L) |
| Enumeration Date | 2005-06-09 |
| Last Update Date | 2016-08-09 |