| NPI | 1689939738 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: OH 58.004698) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: PA OS025151) |
| Enumeration Date | 2012-07-05 |
| Last Update Date | 2025-07-29 |