| NPI | 1225082670 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: OH 35.073733) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: WV 19937) |
| Enumeration Date | 2006-05-20 |
| Last Update Date | 2021-01-21 |