| NPI | 1548343783 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080A0000X Pediatrics, Adolescent Medicine (Licence: MI 4301104556) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MI 4301104556) |
| 2080A0000X Pediatrics, Adolescent Medicine (Licence: OH 35091269) | |
| Enumeration Date | 2006-10-23 |
| Last Update Date | 2019-07-31 |