| NPI | 1669110151 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: OH 35.153615) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: PA MT225360) |
| Enumeration Date | 2022-05-24 |
| Last Update Date | 2025-06-25 |