NPI | 1306824792 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 208000000X Pediatrics (Licence: KY 34779) |
Additional Taxonomies | 208000000X Pediatrics (Licence: OH 35072962) |
2080A0000X Pediatrics, Adolescent Medicine (Licence: KY 34779) | |
2080A0000X Pediatrics, Adolescent Medicine (Licence: OH 35072962P) | |
Enumeration Date | 2006-01-05 |
Last Update Date | 2016-03-08 |