| NPI | 1558321109 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: SC 82192) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: OH 35.089277) |
| Enumeration Date | 2006-03-27 |
| Last Update Date | 2023-01-12 |