| NPI | 1588825566 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: CO 51182) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: OH 35.097154) |
| Enumeration Date | 2008-06-22 |
| Last Update Date | 2018-03-17 |