| NPI | 1356399455 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: OH 34.0066768) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: OH 34.006768) |
| 208000000X Pediatrics (Licence: NC 200400526) | |
| Enumeration Date | 2006-05-04 |
| Last Update Date | 2020-11-25 |