| NPI | 1235123902 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MI 4301043373) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: IL 036-103998) |
| 208000000X Pediatrics (Licence: OH 35.079957) | |
| 208000000X Pediatrics (Licence: WI 48472) | |
| Enumeration Date | 2005-09-08 |
| Last Update Date | 2021-02-03 |