| NPI | 1568434835 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: OH 35.039260) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MI 4301116689) |
| 208000000X Pediatrics (Licence: MO 2018042193) | |
| Enumeration Date | 2006-02-02 |
| Last Update Date | 2023-02-09 |