| NPI | 1184877904 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MN 57271) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: OH 57-015033) |
| 208000000X Pediatrics (Licence: WI 55500) | |
| Enumeration Date | 2008-10-23 |
| Last Update Date | 2021-02-18 |