| NPI | 1518352590 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MD h91895) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: OH 34.013249) |
| Enumeration Date | 2015-04-06 |
| Last Update Date | 2022-05-12 |