| NPI | 1568428316 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080A0000X Pediatrics, Adolescent Medicine (Licence: OH 35.045009) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: OH 35.045009) |
| Enumeration Date | 2006-04-21 |
| Last Update Date | 2024-04-24 |