| NPI | 1407840432 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MI 4301062380) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: OH 35066995) |
| Enumeration Date | 2005-09-06 |
| Last Update Date | 2023-11-15 |