| NPI | 1598723611 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: OH 35.089200) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: TN 20261) |
| Enumeration Date | 2006-05-01 |
| Last Update Date | 2011-01-18 |