| NPI | 1184794166 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NC 201100374) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: OH 34-003238) |
| Enumeration Date | 2006-11-08 |
| Last Update Date | 2013-04-17 |