| NPI | 1538376579 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MA 243466) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: OH 35.093061) |
| Enumeration Date | 2007-05-17 |
| Last Update Date | 2010-06-28 |