| NPI | 1730353558 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208000000X Pediatrics (Licence: CA 20A11235) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: OH 58002205) |
| Enumeration Date | 2008-04-14 |
| Last Update Date | 2021-11-29 |