| NPI | 1295872372 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: LA 204447) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: OH 35.088960) |
| Enumeration Date | 2007-01-30 |
| Last Update Date | 2021-05-20 |