| NPI | 1871586552 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208000000X Pediatrics (Licence: OH 35.064977) |
| Additional Taxonomies | 208000000X Pediatrics (Licence: KY 29129) |
| 174400000X Specialist (Licence: KY 29129) | |
| Enumeration Date | 2005-08-26 |
| Last Update Date | 2015-03-19 |