| NPI | 1396782314 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: OH 35.050817) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: WV 15264) |
| Enumeration Date | 2006-05-31 |
| Last Update Date | 2021-01-21 |