| NPI | 1649250747 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: KY KY32867) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: OH OH35058110L) |
| Enumeration Date | 2006-01-17 |
| Last Update Date | 2024-05-13 |