| NPI | 1841365640 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2080N0001X Pediatrics, Neonatal-Perinatal Medicine (Licence: WV 18922) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: WV 18922) |
| 208000000X Pediatrics (Licence: OH 35065363) | |
| 2080N0001X Pediatrics, Neonatal-Perinatal Medicine (Licence: OH 35065363) | |
| Enumeration Date | 2006-11-21 |
| Last Update Date | 2008-05-27 |