| NPI | 1356329270 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: CA A48078) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: OH 35078453) |
| Enumeration Date | 2006-01-03 |
| Last Update Date | 2025-07-18 |