| NPI | 1588892269 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: MO 2015007373) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: OH 34.010970) |
| 208000000X Pediatrics (Licence: KS 9407255) | |
| Enumeration Date | 2009-07-01 |
| Last Update Date | 2015-07-01 |