| NPI | 1528048980 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: KY KY30786) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: OH OH35061478S) |
| Enumeration Date | 2006-01-20 |
| Last Update Date | 2010-06-14 |