| NPI | 1467451245 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: CA A95570) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: OH 35085012) |
| Enumeration Date | 2005-07-14 |
| Last Update Date | 2023-09-14 |