| NPI | 1386733707 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: OH 35.135647) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NY 175755) |
| Enumeration Date | 2006-10-12 |
| Last Update Date | 2022-03-08 |