| NPI | 1306894381 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: CA G077755) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: OH 35-076473) |
| Enumeration Date | 2006-05-04 |
| Last Update Date | 2011-03-24 |