| NPI | 1609857424 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: OH 35047490) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: MN 28303) |
| Enumeration Date | 2005-11-09 |
| Last Update Date | 2007-07-08 |