| NPI | 1285096339 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: TN 66988) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: OH 35.138523) |
| Enumeration Date | 2016-03-27 |
| Last Update Date | 2023-08-16 |