| NPI | 1538697537 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: OH 34.014921) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: IA DO-05346) |
| 208000000X Pediatrics (Licence: IA R-10953) | |
| Enumeration Date | 2017-06-02 |
| Last Update Date | 2021-04-30 |