| NPI | 1235356528 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: IL 36-133978) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: OH 35-089876) |
| Enumeration Date | 2007-04-19 |
| Last Update Date | 2014-03-18 |