| NPI | 1740273135 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: OH 35-031006) |
| Additional Taxonomies | 208D00000X General Practice (Licence: GA 013646) |
| Enumeration Date | 2005-08-31 |
| Last Update Date | 2007-07-08 |