| NPI | 1497081830 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | Yes | 
| Primary Taxonomy | 2080P0214X Pediatrics, Pediatric Pulmonology (Licence: OH 35.098585) | 
| Additional Taxonomies | 208000000X Pediatrics (Licence: OH 35.098585) | 
| Enumeration Date | 2009-10-20 | 
| Last Update Date | 2015-07-15 |