| NPI | 1861638538 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: OH 35.096888) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: OH 57.014961) |
| Enumeration Date | 2008-12-30 |
| Last Update Date | 2021-04-30 |