| NPI | 1194214320 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: OR MD217757) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: OH 35.147258) |
| 208000000X Pediatrics (Licence: UT 11393172-1205) | |
| Enumeration Date | 2018-05-03 |
| Last Update Date | 2024-09-11 |