| NPI | 1356792832 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MO 2019033338) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: OH 35.144764) |
| Enumeration Date | 2016-06-27 |
| Last Update Date | 2023-10-17 |