| NPI | 1770780280 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: OH 35091191) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: OH 57.007846) |
| Enumeration Date | 2007-06-28 |
| Last Update Date | 2021-12-27 |