| NPI | 1619199346 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: OH 35.088777) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: NC 31577) |
| Enumeration Date | 2007-05-03 |
| Last Update Date | 2017-02-15 |