| NPI | 1194743583 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: NC 2006-01045) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: OH 35-080720) |
| Enumeration Date | 2006-07-17 |
| Last Update Date | 2025-06-03 |