| NPI | 1265055131 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: TX U9525) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: OH 35.147102) |
| Enumeration Date | 2020-05-26 |
| Last Update Date | 2024-07-16 |