| NPI | 1669450003 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: KY 18968) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: OH 35041050) |
| 2080A0000X Pediatrics, Adolescent Medicine (Licence: KY 18968) | |
| 2080A0000X Pediatrics, Adolescent Medicine (Licence: OH 35041050B) | |
| Enumeration Date | 2006-01-05 |
| Last Update Date | 2016-03-08 |