| NPI | 1871530840 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: OH 35-04-5728) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: WV 18084) |
| Enumeration Date | 2006-05-31 |
| Last Update Date | 2014-02-21 |