| NPI | 1427223114 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: OH 35095741) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: OH 57013240) |
| Enumeration Date | 2008-04-24 |
| Last Update Date | 2021-04-22 |