| NPI | 1871556167 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: GA 57992) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: OH 35-086194) |
| Enumeration Date | 2006-04-09 |
| Last Update Date | 2019-09-26 |