| NPI | 1780112649 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: OH 57.246654) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: IA R-10897) |
| Enumeration Date | 2017-05-23 |
| Last Update Date | 2018-06-25 |