| NPI | 1841448321 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: WV 3031) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: KY R1750) |
| 208000000X Pediatrics (Licence: OH 34.012049) | |
| 208000000X Pediatrics (Licence: PA OS015276) | |
| Enumeration Date | 2008-09-08 |
| Last Update Date | 2020-06-30 |