| NPI | 1417118829 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: OH 35092967) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: OH 57.013788) |
| Enumeration Date | 2008-06-18 |
| Last Update Date | 2013-07-18 |