| NPI | 1326544248 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: CA A174261) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: OH 35.141849) |
| Enumeration Date | 2018-03-30 |
| Last Update Date | 2023-03-13 |