| NPI | 1659588903 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2080C0008X Pediatrics, Child Abuse Pediatrics (Licence: SC 91742) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: OH 35090931) |
| Enumeration Date | 2007-05-17 |
| Last Update Date | 2024-05-03 |