| NPI | 1497902225 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: CA A111033) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: OH 57.010311) |
| Enumeration Date | 2008-08-22 |
| Last Update Date | 2021-11-23 |