| NPI | 1649767963 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: UT 11601236-1204) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: OH 34.014343) |
| Enumeration Date | 2018-04-23 |
| Last Update Date | 2024-06-27 |