| NPI | 1205149432 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: OH 35.135506) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: PA MD449124) |
| 208000000X Pediatrics (Licence: OR MD176098) | |
| Enumeration Date | 2010-07-16 |
| Last Update Date | 2021-03-03 |