| NPI | 1326026766 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: OH 35079372) |
| Additional Taxonomies | 2080A0000X Pediatrics, Adolescent Medicine (Licence: OH 35079372B) |
| Enumeration Date | 2006-01-05 |
| Last Update Date | 2019-06-05 |