| NPI | 1265965156 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: DC MD049112) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: OH 35.139491) |
| Enumeration Date | 2017-04-06 |
| Last Update Date | 2022-04-09 |