| NPI | 1578722989 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: PA MD452114) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: OH 35.099120) |
| Enumeration Date | 2008-06-02 |
| Last Update Date | 2014-07-15 |