| NPI | 1346237385 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: OH 35.077587) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NC 2015-01700) |
| 2080A0000X Pediatrics, Adolescent Medicine (Licence: WV 19900) | |
| 2080A0000X Pediatrics, Adolescent Medicine (Licence: OH 35077587) | |
| Enumeration Date | 2005-10-04 |
| Last Update Date | 2018-03-17 |