| NPI | 1467848044 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: OK 34406) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: OH 35.132874) |
| Enumeration Date | 2015-04-10 |
| Last Update Date | 2019-05-20 |