| NPI | 1548207392 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: OH 35-06-5386) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: WV 17614) |
| Enumeration Date | 2006-06-01 |
| Last Update Date | 2014-02-21 |