| NPI | 1497175723 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: OH 35.130923) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: PA MD464085) |
| Enumeration Date | 2014-04-25 |
| Last Update Date | 2021-08-30 |