| NPI | 1477767473 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: PA MD436510) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: OH 57.011699) |
| Enumeration Date | 2007-05-09 |
| Last Update Date | 2025-02-03 |