| NPI | 1649526765 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: CA A119549) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: OH 35. 099330) |
| Enumeration Date | 2012-07-26 |
| Last Update Date | 2013-03-06 |