| NPI | 1821045204 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: OH 35-07-2682) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: WV 19317) |
| 208000000X Pediatrics (Licence: OH 35.072682) | |
| Enumeration Date | 2006-05-30 |
| Last Update Date | 2020-11-04 |