| NPI | 1609261528 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080A0000X Pediatrics, Adolescent Medicine (Licence: OH 35.142651) |
| Additional Taxonomies | 2080A0000X Pediatrics, Adolescent Medicine (Licence: CA A154474) |
| Enumeration Date | 2015-03-30 |
| Last Update Date | 2021-07-07 |