| NPI | 1376885020 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: PA MD482048) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: OH 35.125119) |
| Enumeration Date | 2013-03-20 |
| Last Update Date | 2023-08-14 |